UPDATE Still in Process - warning long vent

  My dear friends, here is an update!!! I called Tricare this morning on my drive in to work.  I found out that there was a question in regards to my file.  You know it is going to be a rough day when the first thing you want when you get to the office is a stiff drink. The nice lady who answered the phone listened to my story and then checked the system.  Here is the scoop.   The nurse assigned to review was questioning why I was not seeing an in network doctor.  I replied that I could answer that question and that I would be more than happy to talk to the nurse.  I was then transferred and left a voice mail which was promptly returned within five minutes.  I explained the situation regarding the use of a out of network doctor, because there are no in network doctors in Illinois.  She said she would continue to review and have an answer by tomorrow.  I asked if possible today?  So, she said heck lets doe this over the phone.  Now mind you when I started this whole process I called the insurance company and asked specifically what would be needed for submission.  No one could answer the question.  Any how, She asked if I had done a supervised 6 month diet?  Um, I did back in 2000, but that is not listed in the benefits/exclusion as a requirement.  She asked where my EKG, Dr. letter of fittness, Dietician visit, and Pulmonolgy results were.  I said excuse me?  I was informed by my surgeons office that all that was need to submit was the Form Requesting Authorization, Letter of Medical Necessity, and the Psyc eval.  She informed me that I needed this stuff prior to being approved.  I said that the surgeon's office has not informed as to what I will need prior to surgery and I can't get this information until you approve me.  Now I am in the catch 22 situation where I need this for approval, and they want me to return to the Navy Hospital for all these test.  I explained that where I am going is a program and not some nut who just cuts on people for the heck of it.  She said that to clear this up she would call my surgeon's office and talk with them, and then call me back this afternoon.  As soon as I hung up with her, I called Maggy and told her what was going on.  She about flipped.  So now I am sittiing and waiting for these phone calls.  The saga will continue.... Thanks to everyone with their kind words of support and the ability to let me rant, vent, cry, whine, and what ever other emotion I have expressed. ******************************************************************************************************** My dear friends, I am sorry that this is a long winded whiny rant/vent, along with a small bit of feeling sad and depressed. Ok, I have tried to be paitient but the amount of time I have prior to the end of the year is disappearing. Because I work in the accounting field, year end is fast approaching, and this means that If I do not get surgery by the middle of December, I will have to wait until the middle of March .

My surgeon's office submitted the paper work on 10/24, I called Tricare on 10/25 to verify the receipt of the paperwork. They said they had the clinicals but not the Request for Authorization form. I then called my surgeon's office and informed the girl who does the insurance of what they said and asked for her to resubmitt the paperwork with one small change. Mark it priority so I could get a response within 72 hours. On 10/27 the web site showed that the paperwork was in process, so I thought cool I should have a response by 11/1 at the latest. Well, on 10/30 I checked the web site and it showed the date changed from 10/27 to 10/30 and in process (WTF!!!). So, I kept waiting and being patient. Well, today 11/6 I am still in process so I got up the nerve and called Tricare at the first chance I got between working on the corporate budgets. I talked with a wonderful woman and explained the whole scenario, she looked in the system and said that yes indeed the paper work shows priority. So she transferred me to the medical management department and I explained the situation again. This time the woman said that oh, this is an inpatient request and you need to talk to another medical management team who deals with these. She gave me a phone number, so I call it and of course it is after 5pm EST so the office was closed. So now I am waiting for the morning to call them. It truly gets disheartening to see all these people get their approvals and surgery dates, and they get them within a day to a week period of time. Every time I check the web site, I have the fear that I will see the word DENIED attached to it. I sort of thought at the beginning of this process is that if your PCM referred you because medically necessary that it was pretty much a given that you would be approved. I to this day have not seen anyone with Tricare being denied (unless I missed that posting).

Crap like this that the insurance companies pull make me feel very sorry for Michelle P (and any insurance coordinators at other doctors offices, too).

As soon as they hear that you need it done by date XXX or it'll have to wait, they will try E.V.E.R.Y.T.H.I.N.G. to try and put hurdles up in front of you to get you frustrated and 'walk away'.  

Good luck in your quest...  Keep on them - call them every other day.  That is what I did with BCBS-IL.  I think they gave in just to get me off their case.  :) 

Its good that are callikng to check. Keep them on your toes. Once you get approved does your surgeon schedule  right away?? Hang in there

Dear Wendi: I understand your predicament completely.  It is now morning, and I hope that you get some answers today.  Definately STAY ON THEM!!!!  I have not heard of anyone with Tri-Care being denied either, but keep after them. I've got everything crossed for you! And by the way, thanks for the heating pad suggestion.....that might work.  I am definately going to get some foot warmers too.

Geez Louise! Do they want you to walk on water and play the bango too. I don't blame you Wendi I would be flippin mad. Hang in there and keep pestering them.  I know in my heart that you will get through this.

Don'tcha feel just like Dorothy in the Wizard of OZ? I sure did while I was going through it.   Hang in there, we are all pulling for you and I know it will work out in the end.......